Growth hormone (GH), which is secreted from the pituitary gland, stimulates growth of all tissues of the body that are capable of growing. In addition, growth hormone is known to have the following basic effects on the metabolic process of the body:
1. Increased rate of protein synthesis in substantially all cells of the body; PA1 2. Decreased rate of carbohydrate utilization in cells of the body; PA1 3. Increased mobilization of free fatty acids and use of fatty acids for energy. PA1 where the alkyl and cycloalkyl groups in the definition of R.sup.1 are optionally substituted with (C.sub.1 -C.sub.4)alkyl, hydroxyl, (C.sub.1 -C.sub.4)alkoxy, carboxyl, --CONH.sub.2, --S(O).sub.m (C.sub.1 -C.sub.6)alkyl, --CO.sub.2 (C.sub.1 -C.sub.4)alkyl ester, 1H-tetrazol-5-yl or 1, 2 or 3 fluoro; PA1 Y.sup.1 is O, S(O).sub.m, --C(O)NX.sup.6 -, --CH.dbd.CH--, --C.tbd.C--, --N(X.sup.6)C(O)--, --C(O)NX.sup.6 -, --C(O)O--, --OC(O)N(X.sup.8)- or --OC(O)--; PA1 q is 0, 1, 2, 3 or 4; PA1 t is 0, 1, 2 or 3; PA1 said (CH.sub.2).sub.q group and (CH.sub.2).sub.t group may each be optionally substituted with hydroxyl, (C.sub.1 -C.sub.4)alkoxy, carboxyl, --CONH.sub.2, --S(O).sub.m (C.sub.1 -C.sub.6)alkyl, --CO.sub.2 (C.sub.1 -C.sub.4)alkyl ester, 1H-tetrazol-5-yl, 1, 2 or 3 fluoro, or 1 or 2 (C.sub.1 -C.sub.4)alkyl; PA1 where the alkyl groups in the definition of R.sup.3 are optionally substituted with, --S(O).sub.m (C.sub.1 -C.sub.6)alkyl, --C(O)OX.sup.3, 1, 2, 3, 4 or 5 halogens, or 1, 2 or 3 OX.sup.3, X.sup.1 is O, S(O).sub.m, --N(X.sup.2)C(O)--, --C(O)N(X.sup.2)- or --C.tbd.C--; PA1 or the carbon bearing X.sup.5 or X.sup.5a forms one or two alkylene bridges with the nitrogen atom bearing R.sup.6 and R.sup.8 wherein each alkylene bridge contains 1 to 5 carbon atoms, provided that when one alkylene bridge is formed then X.sup.5 or X.sup.5a but not both may be on the carbon atom and R.sup.6 or R.sup.8 but not both may be on the nitrogen atom and further provided that when two alkylene bridges are formed then X.sup.5 and X.sup.5a cannot be on the carbon atom and R.sup.7 and R.sup.8 cannot be on the nitrogen atom; PA1 or X.sup.5 is taken together with X.sup.5a and the carbon atom to which they are attached and form a partially saturated or fully saturated 3- to 7-membered ring, or a partially saturated or fully saturated 4- to 8-membered ring having 1 to 4 heteroatoms independently selected from the group consisting of oxygen, sulfur and nitrogen; PA1 or X.sup.5 is taken together with X.sup.5a and the carbon atom to which they are attached and form a bicyclic ring system consisting of a partially saturated or fully saturated 5- or 6-membered ring, optionally having 1 or 2 heteroatoms independently selected from the group consisting of nitrogen, sulfur and oxygen, fused to a partially saturated, fully saturated or fully unsaturated 5- or 6-membered ring, optionally having 1 to 4 heteroatoms independently selected from the group consisting of nitrogen, sulfur and oxygen; PA1 Z.sup.1 is a bond, O or N--X.sup.2, provided that when a and b are both 0 then Z.sup.1 is not N--X.sup.2 or O; PA1 where the optionally substituted (C.sub.1 -C.sub.8)alkyl in the definition of R.sup.7 and R.sup.8 is optionally independently substituted with A.sup.1, --C(O)O-(C.sub.1 -C.sub.6)alkyl, --S(O).sub.m (C.sub.1 -C.sub.6)alkyl, 1 to 5 halogens, 1 to 3 hydroxy, 1 to 3 --O--C(O)(C.sub.1 -C.sub.10)alkyl or 1 to 3 (C.sub.1 -C.sub.8)alkoxy; or PA1 where L is C(X.sup.2)(X.sup.2), S(O).sub.m or N(X.sup.2); PA1 A.sup.1 for each occurrence is independently optionally substituted, in one or optionally both rings if A.sup.1 is a bicyclic ring system, with up to three substituents, each substituent independently selected from the group consisting of F, Cl, Br, I, OCF.sub.3, OCF.sub.2 H, CF.sub.3, CH.sub.3, OCH.sub.3, --OX.sup.6, --C(O)N(X.sup.8)(X.sup.6), --C(O)OX.sup.8, oxo, (C.sub.1 -C.sub.8)alkyl, nitro, cyano, benzyl, --S(O).sub.m (C.sub.1 1.varies.C.sub.6)alkyl, 1H-tetrazol-5-yl, phenyl, phenoxy, phenylalkyloxy, halophenyl, methylenedioxy, --N(X.sup.6)(X.sup.8), --N(X.sup.8)C(O)(X.sup.6), --SO.sub.2 N(X.sup.6)(X.sup.8), --N(X.sup.5)SO.sub.2 -phenyl, --N(X.sup.6)SO.sub.2 X.sup.6, --CONX.sup.11 X.sup.12, --SO.sub.2 NX.sup.11 X.sup.12, --NX.sup.6 SO.sub.2 X.sup.12, --NX.sup.6 CONX.sup.11 X.sup.12, --NX.sup.8 SO.sub.2 NX.sup.11 X.sup.12, --NX.sup.6 C(O)X.sup.12, imidazolyl, thiazolyl or tetrazolyl, provided that if A.sup.1 is optionally substituted with methylenedioxy then it can only be substituted with one methylenedioxy; PA1 X.sup.7 is hydrogen or (C.sub.1 -C.sub.8)alkyl optionally substituted with hydroxyl; and PA1 where the optionally substituted (C.sub.1 -C.sub.6)alkyl is optionally substituted with OX.sup.2, imidazolyl, phenyl, indolyl, p-hydroxyphenyl, (C.sub.5 -C.sub.7)cycloalkyl, --S(O).sub.m (C.sub.1 -C.sub.6)alkyl, --N(X.sup.2)(X.sup.2) or --C(O)N(X.sup.2)(X.sup.2); PA1 where the aryl portion(s) of the groups defined for R.sup.3 are optionally substituted with one to three substituents, each substituent being independently selected from the group consisting of methylenedioxy, F, Cl, CH.sub.3, OCH.sub.3, OCF.sub.3, OCF.sub.2 H and CF.sub.3. PA1 where the aryl portion of the groups defined for R.sup.3 is optionally substituted with one to three substituents, each substituent being independently selected from the group consisting of fluoro, chloro, methyl, OCH.sub.3, OCF.sub.2 H, OCF.sub.3 and CF.sub.3. PA1 where A.sup.1 in the definition of R.sup.1 is optionally substituted with one to three substituents, each substituent being independently selected from the group consisting of fluoro, chloro, methyl, OCH.sub.3, OCF.sub.2 H, OCF.sub.3 and CF.sub.3 ; the cycloalkyl and alkyl groups in the definition of R.sup.1 are optionally substituted with (C.sub.1 -C.sub.4)alkyl, hydroxyl, (C.sub.1 -C.sub.4)alkoxy, carboxyl, CONH.sub.2, --S(O).sub.m (C.sub.1 -C.sub.6)alkyl, --CO.sub.2 (C.sub.1 -C.sub.4)alkyl ester, 1H-tetrazol-5-yl or 1 to 3 fluoro; PA1 where A.sup.1 in the definition of R.sup.1 is phenyl, thienyl, thiazolyl, pyridyl or pyrimidyl which is optionally substituted with one to three substituents, each substituent being independently selected from the group consisting of F, Cl, Me, OMe, CF.sub.3, OCF.sub.3 and OCF.sub.2 H; PA1 t is 0, 1 or 2; PA1 where A.sup.1 in the definition of R.sup.1 is phenyl, thienyl, thiazolyl, pyridyl or pyrimidyl which is optionally substituted with one to three substituents, each substituent being independently selected form the group consisting of F, Cl, Me, OMe, CF.sub.3, OCF.sub.3 and OCF.sub.2 H; PA1 where the aryl portion(s) of the groups defined for R.sup.2 are optionally substituted with one to three substituents, each substituent being independently selected from the group consisting of methylenedioxy, F, Cl, CH.sub.3, OCH.sub.3, OCF.sub.3, OCF.sub.2 H and CF.sub.3. PA1 where the alkyl and cycloalkyl groups in the definition of R.sup.1 are optionally substituted with (C.sub.1 -C.sub.4)alkyl, hydroxyl, (C.sub.1 -C.sub.4)alkoxy, carboxyl, CONH.sub.2, --S(O).sub.m (C.sub.1 -C.sub.6)alkyl, --CO.sub.2 (C.sub.1 -C.sub.4)alkyl, 1H-tetrazol-5-yl or 1 to 3 fluoro; Y.sup.1 is O,, S(O).sub.m, --C(O)NX.sup.6, --CH.dbd.CH--, --C.tbd.C--, --N(X.sup.6)C(O)--, --C(O)NX.sup.6 -, --C(O)O--, --OC(O)N(X.sup.6)- or --OC(O)--; q is 0, 1, 2, 3 or 4; t is 0, 1, 2 or 3; PA1 said (CH.sub.2).sub.q group and (CH.sub.2).sub.t group may each be optionally substituted with 1 to 3fluoro, 1 or 2 (C.sub.1 -C.sub.4)alkyl, hydroxyl, (C.sub.1 -C.sub.4)alkoxy, carboxyl, --CONH.sub.2, --S(O).sub.m (C.sub.1 -C.sub.6)alkyl, --CO.sub.2 (C.sub.1 -C.sub.4)alkyl ester, or 1H-tetrazol-5-yl; PA1 A.sup.1 for each occurrence is independently optionally substituted, in one or optionally both rings if A.sup.1 is a bicyclic ring system, with up to three substituents, each substituent independently selected from the group consisting of F, Cl, Br, I, OCF.sub.3, OCF.sub.2 H, CF.sub.3, CH.sub.3, OCH.sub.3, --OX.sup.6, --C(O)N(X.sup.6)(X.sup.6), --C(O)OX.sup.6, oxo, (C.sub.1 -C.sub.6)alkyl, nitro, cyano, benzyl, --S(O).sub.m (C.sub.1 -C.sub.5)alkyl, 1H-tetrazol-5-yl, phenyl, phenoxy, phenylalkyloxy, halophenyl, methylenedioxy, --N(X.sup.6)(X.sup.6), --N(X.sup.6)C(O)(X.sup.6), --SO.sub.2 N(X.sup.6)(X.sup.6), --N(X.sup.5)SO.sub.2 -phenyl, --N(X.sup.6)SO.sub.2 X.sup.6, --CONX.sup.11 X.sup.12, --SO.sub.2 NX.sup.11 X.sup.12, --NX.sup.6 SO.sub.2 X.sup.12, --NX.sup.6 CONX.sup.11 X.sup.12, --NX.sup.6 SO.sub.2 NX.sup.11 X.sup.12, --NX.sup.6 C(O)X.sup.12, imidazolyl, thiazolyl and tetrazolyl, provided that if A.sup.1 is optionally substituted with methylenedioxy then it can only be substituted by one methylenedioxy; PA1 where the alkyl and cycloalkyl groups in the definition of R.sup.1 are optionally substituted with (C.sub.1 -C.sub.4)alkyl, hydroxyl, (C.sub.1 -C.sub.4)alkoxy, carboxyl, CONH.sub.2, --S(O).sub.m (C.sub.1 -C.sub.6)alkyl, --CO.sub.2 (C.sub.1 -C.sub.4)alkyl, 1H-tetrazol-5-yl or 1 to 3 fluoro; PA1 Y.sup.1 is O, S(O).sub.m, --C(O)NX.sup.6, --CH.dbd.CH--, --C.tbd.C--, --N(X.sup.6)C(O), --C(O)NX.sup.6, --C(O)O, --OC(O)N(X.sup.6) or --OC(O); PA1 q is 0, 1, 2, 3 or 4; PA1 t is 0, 1, 2 or 3; PA1 said (CH.sub.2).sub.q group and (CH.sub.2).sub.t group may each be optionally substituted with hydroxyl, (C.sub.1 -C.sub.4)alkoxy, carboxyl, --CONH.sub.2, --S(O).sub.m (C.sub.1 -C.sub.6)alkyl, --CO.sub.2 (C.sub.1 -C.sub.4)alkyl, 1H-tetrazol-5-yl, 1 to 3 fluoro or 1 or 2 (C.sub.1 -C.sub.4)alkyl; PA1 A.sup.1 for each occurrence is independently optionally substituted, in one or optionally both rings if A.sup.1 is a bicyclic ring system, with up to three substituents, each substituent independently selected from the group consisting of F, Cl, Br, I, OCF.sub.3, OCF.sub.2 H, CF.sub.3, CH.sub.3, OCH.sub.3, --OX.sup.6, --C(O)N(X.sup.8)(X.sup.6), --C(O)OX.sup.6, oxo, (C.sub.1 -C.sub.6)alkyl, nitro, cyano, benzyl, --S(O).sub.m (C.sub.1 -C.sub.7)alkyl, 1H-tetrazol-5-yl, phenyl, phenoxy, phenylalkyloxy, halophenyl, methylenedioxy, --N(X.sup.6)(X.sup.6), --N(X.sup.6)C(O)(X.sup.6), --SO.sub.2 N(X.sup.6)(X.sup.6), --N(X.sup.6)SO.sub.2 -phenyl, --N(X.sup.6)SO.sub.2 X.sup.6, --CONX.sup.11 X.sup.12, --SO.sub.2 NX.sup.11 X.sup.12, --NX.sup.6 SO.sub.2 X.sup.12, --NX.sup.6 CONX.sup.11 X.sup.12, --NX.sup.6 SO.sub.2 NX.sup.11 X.sup.12, --NX.sup.6 C(O)X.sup.12, imidazolyl, thiazolyl and tetrazolyl, provided that if A.sup.1 is optionally substituted with methylenedioxy then it can only be substituted with one methylenedioxy; PA1 where X.sup.11 is hydrogen or optionally substituted (C.sub.1 -C.sub.6)alkyl; PA1 X.sup.12 is hydrogen, (C.sub.1 -C.sub.8)alkyl, phenyl, thiazolyl, imidazolyl, furyl or thienyl, provided that when X.sup.12 is not hydrogen, X.sup.12 is optionally substituted with one to three substituents independently selected from the group consisting of Cl, F, CH.sub.3, OCH.sub.3, OCF.sub.3 and CF.sub.3 ; PA1 or X.sup.11 and X.sup.12 are taken together to form --(CH.sub.2).sub.t --L.sup.1 --(CH.sub.2).sub.t --; PA1 m for each occurrence is independently 0, 1 or 2; PA1 X.sup.6 and X.sup.12 cannot be hydrogen when it is attached to C(O) or SO.sub.2 in the form C(O)X.sup.6, C(O)X.sup.12, SO.sub.2 X.sup.6 or SO.sub.2 X.sup.12 ; PA1 when R.sup.2 is hydrogen then R.sup.1 is not --CH.dbd.CH-phenyl; PA1 when R.sup.2 is H and R.sup.1 is --CH.sub.2 --CH.dbd.CH-Ph, then Z.sup.100 is not BOC; PA1 when R.sup.2 is H and R.sup.1 is then Z.sup.100 is not BOC; PA1 when R.sup.2 is H and R.sup.1 is --CH.sub.2 --C(CH.sub.3).dbd.CH.sub.2, then Z.sup.100 is not BOC; and PA1 when R.sup.2 is phenyl and R.sup.1 is --CH.sub.3, then Z.sup.100 is not CH.sub.3 C(O)--. PA1 Z.sup.100 is BOC, methyl, benzyl or CBZ; PA1 R.sup.1 is hydrogen, --(CH.sub.2).sub.q --(C.sub.3 -C.sub.7)cycloalkyl, --(CH.sub.2).sub.1 --A.sup.1 or (C.sub.1 -C.sub.10)alkyl where the (C.sub.1 -C.sub.10)alkyl and (C.sub.3 -C.sub.7)cycloalkyl groups are optionally substituted with 1 to 3 fluoro and A.sup.1 in the definition of R.sup.1 is optionally substituted with 1 to 3 substituents independently selected from the group consisting of F, Cl, Me, OMe, CF.sub.3, OCF.sub.3 and OCF.sub.2 H; PA1 R.sup.2 is hydrogen, (C.sub.1 -C.sub.8)alkyl, --(C.sub.0 -C.sub.3)alkyl--(C.sub.3 -C.sub.7)cycloalkyl, phenyl, or --(C.sub.1 -C.sub.3)alkylphenyl where the alkyl and phenyl groups are optionally substituted with 1 to 3 substituents independently selected from the group consisting of F, CF.sub.3, OH and OMe. PA1 Z.sup.200 is t-BOC, CBZ, CF.sub.3 C(O)--, FMOC, TROC, trityl, tosyl or optionally substituted benzyl which is optionally substituted with methoxy, dimethoxy or nitro; PA1 e is 0 or 1; PA1 n and w are each independently 0, 1 or 2, provided that w and n cannot both be 0 at the same time; PA1 Y is oxygen or sulfur; PA1 R.sup.1 is hydrogen, --CN, --(CH.sub.2).sub.q N(X.sup.6)C(O)X.sup.6, --(CH.sub.2).sub.q N(X.sup.8)C(O)(CH.sub.2).sub.t --A.sup.1, --(CH.sub.2).sub.q N(X.sup.6)SO.sub.2 (CH.sub.2).sub.t --A.sup.1, --(CH.sub.2).sub.q N(X.sup.6)SO.sub.2 X.sup.6, --(CH.sub.2).sub.q N(X.sup.6)C(O)N(X.sup.6)(CH.sub.2).sub.t --A.sup.1, --(CH.sub.2).sub.q N(X.sup.6)C(O)N(X.sup.6)(X.sup.6), --(CH.sub.2).sub.q C(O)N(X.sup.6)(X.sup.6), --(CH.sub.2).sub.q C(O)N(X.sup.6)(CH.sub.2).sub.t --A.sup.1, --(CH.sub.2).sub.q C(O)OX.sup.6, --(CH.sub.2).sub.q C(O)O(CH.sub.2).sub.t --A.sup.1, --(CH.sub.2).sub.q OX.sup.6, --(CH.sub.2).sub.q OC(O)X.sup.6, --(CH.sub.2).sub.q OC(OXCH.sub.2).sub.t --A.sup.1, --(CH.sub.2).sub.q OC(O)N(X.sup.6)(CH.sub.2).sub.t --A.sup.1, --(CH.sub.2).sub.q OC(O)N(X.sup.6)(X.sup.6), --(CH.sub.2).sub.q C(O)X.sup.6, --CH.sub.2).sub.q C(O)(CH.sub.2).sub.t --A.sup.1, --(CH.sub.2).sub.q N(X.sup.6)C(O)OX.sup.6, --(CH.sub.2).sub.q N(X.sup.6)SO.sub.2 N(X.sup.6)(X.sup.6), --(CH.sub.2).sub.q S(O).sub.m X.sup.6, --(CH.sub.2).sub.q S(O).sub.m (CH.sub.2).sub.t --A.sup.1, --(C.sub.1 -C.sub.10)alkyl, --(CH.sub.2).sub.t --A.sup.1, --(CH.sub.2).sub.q --(C.sub.3 -C.sub.7)cycloalkyl, --(CH.sub.2).sub.q --Y.sup.1 --(C.sub.1 -C.sub.6)alkyl, --(CH.sub.2).sub.q --Y.sup.1 --(CH.sub.2).sub.t --A.sup.1 or --(CH.sub.2).sub.q --Y.sup.1 --(CH.sub.2).sub.t --(C.sub.3 -C.sub.7)cycloalkyl; PA1 R.sup.2 is hydrogen, (C.sub.1 -C.sub.8)alkyl, --(C.sub.0 -C.sub.3)alkyl--(C.sub.3 -C.sub.6)cycloalkyl, --(C.sub.1 -C.sub.4)alkyl--A.sup.1 or A.sup.1 ; where the alkyl groups and the cycloalkyl groups in the definition of R.sup.2 are optionally substituted with hydroxyl, --C(O)OX.sup.6, --C(O)N(X.sup.6)(X.sup.6), --N(X.sup.6)(X.sup.6), --S(O).sub.m (C.sub.1 -C.sub.6)alkyl, --C(O)A.sup.1, --C(O)(X.sup.6), CF.sub.3, CN or 1 to 3 halogen; PA1 R.sup.3 is A.sup.1, (C.sub.1 -C.sub.10)alkyl, --(C.sub.1 -C.sub.6)alkyl--A.sup.1, --(C.sub.1 -C.sub.6)alkyl--(C.sub.3 -C.sub.7)cycloalkyl, --(C.sub.1 -C.sub.5)alkyl--X.sup.1 --(C.sub.1 -C.sub.5)alkyl, --(C.sub.1 -C.sub.5)alkyl-X.sup.1 --(C.sub.0 -C.sub.5)alkyl--A.sup.1 or --(C.sub.1 -C.sub.5)alkyl-X.sup.1 -(C.sub.1 -C.sub.5)alkyl--(C.sub.3 -C.sub.7)cycloalkyl; PA1 R.sup.4 is hydrogen, (C.sub.1 -C.sub.6)alkyl or (C.sub.3 -C.sub.7)cycloalkyl, or R.sup.4 is taken together with R.sup.3 and the carbon atom to which they are attached and form (C.sub.5 -C.sub.7)cycloalkyl, (C.sub.5 -C.sub.7)cycloalkenyl, a partially saturated or fully saturated 4- to 8-membered ring having 1 to 4 heteroatoms independently selected from the group consisting of oxygen, sulfur and nitrogen, or is a bicyclic ring system consisting of a partially saturated or fully saturated 5- or 6-membered ring, fused to a partially saturated, fully unsaturated or fully saturated 5- or 6-membered ring, optionally having 1 to 4 heteroatoms independently selected from the group consisting of nitrogen, sulfur and oxygen; PA1 X.sup.4 is hydrogen or (C.sub.1 -C.sub.6)alkyl or X.sup.4 is taken together with R.sup.4 and the nitrogen atom to which X.sup.4 is attached and the carbon atom to which R.sup.4 is attached and form a five to seven membered ring; ##STR12## where a and b are independently 0, 1, 2 or 3; X.sup.5 and X.sup.5a are each independently selected from the group consisting of hydrogen, trifluoromethyl, A.sup.1 and optionally substituted (C.sub.1 -C.sub.6)alkyl; PA1 or the carbon bearing X.sup.5 and X.sup.5a forms an alkylene bridge with the nitrogen atom bearing Z.sup.200 and R.sup.8 where the alkylene bridge contains 1 to 5 carbon atoms provided that X.sup.5 or X.sup.5a but not both may be on the carbon atom and Z.sup.200 or R.sup.8 but not both may be on the nitrogen atom; PA1 or X.sup.5 is taken together with X.sup.5a and the carbon atom to which they are attached and form a partially saturated or fully saturated 3- to 7-membered ring, or a partially saturated or fully saturated 4- to 8-membered ring having 1 to 4 heteroatoms independently selected from the group consisting of oxygen, sulfur and nitrogen; PA1 or X.sup.5 is taken together with X.sup.5a and the carbon atom to which they are attached and form a bicyclic ring system consisting of a partially saturated or fully saturated 5- or 6-membered ring, optionally having 1 or 2 heteroatoms independently selected from the group consisting of nitrogen, sulfur and oxygen, fused to a partially saturated, fully saturated or fully unsaturated 5- or 6-membered ring, optionally having 1 to 4 heteroatoms independently selected from the group consisting of nitrogen, sulfur and oxygen; PA1 Z.sup.1 is a bond, O or N--X.sup.2, provided that when a and b are both 0 then Z.sup.1 is not N--X.sup.2 or O; PA1 R.sup.8 is hydrogen or optionally substituted (C.sub.1 -C.sub.6)alkyl; PA1 A.sup.1 for each occurrence is independently (C.sub.5 -C.sub.7)cycloalkenyl, phenyl or a partially saturated, fully saturated or fully unsaturated 4- to 8-membered ring optionally having 1 to 4 heteroatoms independently selected from the group consisting of oxygen, sulfur and nitrogen, or a bicyclic ring system consisting of a partially saturated, fully unsaturated or fully saturated 5- or 6-membered ring, optionally having 1 to 4 heteroatoms independently selected from the group consisting of nitrogen, sulfur and oxygen, fused to a partially saturated, fully saturated or fully unsaturated 5- or 6-membered ring, optionally having 1 to 4 heteroatoms independently selected from the group consisting of nitrogen, sulfur and oxygen; PA1 r for each occurrence is independently 1, 2 or 3; PA1 X.sup.2 for each occurrence is independently hydrogen, optionally substituted (C.sub.1 -C.sub.6)alkyl, or optionally substituted (C.sub.3 -C.sub.7)cycloalkyl, where the optionally substituted (C.sub.1 -C.sub.6)alkyl and optionally substituted (C.sub.3 -C.sub.7)cycloalkyl in the definition of X.sup.2 are optionally independently substituted with --S(O).sub.m (C.sub.1 -C.sub.6)alkyl, --C(O)OX.sup.3, 1 to 5 halogens or 1 to 3 --OX.sup.3 ; PA1 X.sup.3 for each occurrence is independently hydrogen or (C.sub.1 -C.sub.6)alkyl; PA1 X.sup.6 for each occurrence is independently hydrogen, optionally substituted (C.sub.1 -C.sub.6)alkyl, (C.sub.2 -C.sub.6)halogenated alkyl, optionally substituted (C.sub.3 -C.sub.7)cycloalkyl, (C.sub.3 -C.sub.7)-halogenated cycloalkyl, where optionally substituted (C.sub.1 -C.sub.6)alkyl and optionally substituted (C.sub.3 -C.sub.7)cycloalkyl in the definition of X.sup.6 is optionally independently substituted with hydroxyl, (C.sub.1 -C.sub.4)alkoxy, carboxyl, CONH.sub.2, --S(O).sub.m (C.sub.1 -C.sub.6)alkyl, --CO.sub.2 (C.sub.1 -C.sub.4)alkyl, 1-H-tetrazol-5-yl or 1 or 2 (C.sub.1 -C.sub.4)alkyl; or PA1 when there are two X.sup.6 groups on one atom and both X.sup.6 are (C.sub.1 -C.sub.6)alkyl, the two (C.sub.1 -C.sub.6)alkyl groups may be optionally joined and, together with the atom to which the two X.sup.6 groups are attached, form a 4- to 9-membered ring optionally having oxygen, sulfur or NX.sup.7 ; PA1 m for each occurrence is independently 0, 1 or 2; PA1 X.sup.6 and X.sup.12 cannot be hydrogen when it is attached to C(O) or SO.sub.2 in the form C(O)X.sup.6, C(O)X.sup.12, SO.sub.2 X.sup.6 or SO.sub.2 X.sup.12 ; and PA1 when R.sup.6 is a bond then L is N(X.sup.2) and each r in the definition --(CH.sub.2).sub.r --L--(CH.sub.2).sub.r -- is 2 or 3. PA1 a method for increasing levels of endogenous growth hormone in a human or other animal which comprises administering to such human or other animal an effective amount of a compound of Formula I; PA1 a pharmaceutical composition useful for increasing the endogenous production or release of growth hormone in a human or other animal which comprises an inert carrier and an effective amount of a compound of Formula I; PA1 a pharmaceutical composition useful for increasing the endogenous production or release of growth hormone in a human or other animal which comprises an inert carrier, an effective amount of a compound of Formula I and another growth hormone secretagogue such as, GHRP-6, Hexarelin, GHRP-1, IGF-1, IGF-2, B-HT920 or growth hormone releasing factor (GRF) or an analog thereof; PA1 a method for the treatment or prevention of osteoporosis which comprises administering to a human or other animal in need of such treatment or prevention an amount of a compound of Formula I which is effective in treating or preventing osteoporosis; PA1 a method for the treatment or prevention of osteoporosis which comprises administering to a human or other animal with osteoporosis a combination of a bisphosphonate compound such as alendronate, and especially preferred is the bisphosphonate compound ibandronate, and a compound of Formula I; PA1 a method for the treatment or prevention of osteoporosis which comprises administering to a human or other animal with osteoporosis a combination of estrogen or Premarin.RTM. and a compound of Formula I and optionally progesterone; PA1 a method to increase IGF-1 levels in IGF-1 deficient humans or other animals which comprises administering to a human or other animal with IGF-1 deficiency a compound of Formula I; PA1 a method for the treatment of osteoporosis which comprises administering to a human or other animal with osteoporosis a combination of an estrogen agonist or antagonist such as tamoxifen, droloxifene, raloxifene and idoxifene and a compound of Formula I; PA1 a particularly preferred method for the treatment of osteoporosis comprises administering to a human or other animal with osteoporosis a combination of an estrogen agonist or antagonist such as Cis-6-(4-fluoro-phenyl)-5-[4-(2-piperidin-1-yl-ethoxy)-phenyl]-5,6,7,8-tet rahydro-naphthalene-2-ol; PA1 (-)-cis-6-phenyl-5-[4-(2-pyrrolidin-1-yl-ethoxy)-phenyl]-5,6,7,8-tetrahydro naphthalene-2-ol; PA1 cis-6-phenyl-5-[4-(2-pyrrolidin-1-yl-ethoxy)-phenyl]-5,6,7,8-tetrahydronaph thalene-2-ol; PA1 cis-1-[6'-pyrrolodinoethoxy-3'-pyridyl]-2-phenyl-6-hydroxy-1,2,3,4-tetrahyd ronaphthalene; PA1 1-(4'-pyrrolidinoethoxyphenyl)-2-(4"-fluorophenyl)-6-hydroxy-1,2,3,4-tetrah ydroisoquinoline; PA1 cis-6-(4-hydroxyphenyl)-5-[4-(2-piperidin-1-yl-ethoxy)-phenyl]-5,6,7,8-tetr ahydro-naphthalene-2-ol; or PA1 1-(4'-pyrrolidinoethoxyphenyl)-2-phenyl-6-hydroxy-1,2,3,4-tetrahydro-isoqui noline and a compound of Formula I; PA1 a method for the treatment of osteoporosis which comprises administering to a human or other animal with osteoporosis a combination of calcitonin and a compound of Formula I; PA1 a method for increasing muscle mass, which method comprises administering to a human or other animal in need of such treatment an amount of a compound of Formula I which is effective in promoting release of endogenous growth hormone; and PA1 a method for promoting growth in growth hormone deficient children which comprises administering to a growth hormone deficient child a compound of Formula I which is effective in promoting release of endogenous growth hormone. PA1 cis-6-(4-fluoro-phenyl)-5-[4-(2-piperidin-1-yl-ethoxy)-phenyl]-5,6,7,8-tetr ahydro-naphthalene-2-ol; PA1 (-)-cis-6-phenyl-5-[4-(2-pyrrolidin-1-yl-ethoxy)-phenyl]-5,6,7,8-tetrahydro -naphthalene-2-ol; PA1 cis-6-phenyl-5-[4-(2-pyrrolidin-1-yl-ethoxy)-phenyl]-5,6,7,8-tetrahydro-nap hthalene-2-ol; PA1 cis-1-[6'-pyrrolodinoethoxy-3'-pyridyl]-2-phenyl-6-hydroxy-1,2,3,4-tetrahyd ronaphthalene; PA1 1(4'-pyrrolidinoethoxyphenyl)-2-(4"-fluorophenyl)-6-hydroxy-1,2,3,4-tetrahy droisoquinoline; PA1 cis-6-(4-hyroxyphenyl)-5-[4-(2-piperidin-1-yl-ethoxy)-phenyl]-5,6,7,8-tetra hydro-naphthalene-2-ol; and PA1 1-(4'-pyrrolidinoethoxyphenyl)-2-phenyl-6-hydroxy-1,2,3,4-tetrahydroisoquin oline. PA1 cis-6-(4-fluoro-phenyl)-5-[4-(2-piperidin-1-yl-ethoxy)-phenyl]-5,6,7,8-tetr ahydronaphthalene-2-ol; PA1 (-)-cis-6-phenyl-5-[4-(2-pyrrolidin-1-yl-ethoxy)-phenyl]-5,6,7,8-tetrahydro naphthalene-2-ol; PA1 cis-6-phenyl-5-[4-(2-pyrrolidin-1-yl-ethoxy)-phenyl]-5,6,7,8-tetrahydronaph thalene-2-ol; PA1 cis-1-[6'-pyrrolodinoethoxy-3'-pyridyl]-2-phenyl-6-hydroxy-1,2,3,4-tetrahyd ronaphthalene; PA1 1-(4'-pyrrolidinoethoxyphenyl)-2-(4"-fluorophenyl)-6-hydroxy-1,2,3,4-tetrah ydroisoquinoline; PA1 cis-6-(4-hydroxyphenyl)-5-[4-(2-piperidin-1-yl-ethoxy)-phenyl]-5,6,7,8-tetr ahydro-naphthalene-2-ol; or PA1 1-(4'-pyrrolidinoethoxyphenyl)-2-phenyl-6-hydroxy-1,2,3,4-tetrahydroisoquin oline is in the range of 0.0001 to 100 mg/kg/day, preferably 0.001 to 10 mg/kg/day.
Deficiency in growth hormone results in a variety of medical disorders. In children, it causes dwarfism. In adults, the consequences of acquired GH deficiency include profound reduction in lean body mass and concomitant increase in total body fat, particularly in the truncal region. Decreased skeletal and cardiac muscle mass and muscle strength lead to a significant reduction in exercise capacity. Bone density is also reduced. Administration of exogenous growth hormone has been shown to reverse many of the metabolic changes. Additional benefits of therapy have included reduction in LDL cholesterol and improved psychological well-being.
In cases where increased levels of growth hormone were desired, the problem was generally solved by providing exogenous growth hormone or by administering an agent which stimulated growth hormone production and/or release. In either case the peptidyl nature of the compound necessitated that it be administered by injection. Initially the source of growth hormone was the extraction of the pituitary glands of cadavers. This resulted in an expensive product, and carried with it the risk that a disease associated with the source of the pituitary gland could be transmitted to the recipient of the growth hormone (e.g., Jacob-Creutzfeld disease). Recently, recombinant growth hormone has become available which, while no longer carrying any risk of disease transmission, is still a very expensive product which must be given by injection or by a nasal spray.
Most GH deficiencies are caused by defects in GH release, not primary defects in pituitary synthesis of GH. Therefore, an alternative strategy for normalizing serum GH levels is by stimulating its release from somatotrophs. Increasing GH secretion can be achieved by stimulating or inhibiting various neurotransmitter systems in the brain and hypothalamus. As a result, the development of synthetic growth hormone-releasing agents to stimulate pituitary GH secretion are being pursued, and may have several advantages over expensive and inconvenient GH replacement therapy. By acting along physiologic regulatory pathways, the most desirable agents would stimulate pulsatile GH secretion, and excessive levels of GH that have been associated with the undesirable side effects of exogenous GH administration would be avoided by virtue of intact negative feedback loops.
Physiologic and pharmacologic stimulators of GH secretion include arginine, L-3,4-dihydroxyphenylalanine (L-DOPA), glucagon, vasopressin, and insulin induced hypoglycemia, as well as activities such as sleep and exercise, indirectly cause growth hormone to be released from the pituitary by acting in some fashion on the hypothalamus perhaps either to decrease somatostatin secretion or to increase the secretion of the known secretagogue growth hormone releasing factor (GHRF) or an unknown andogenous growth hormone-releasing hormone or all of these.
Other compounds have been developed which stimulate the release of endogenous growth hormone such as analogous peptidyl compounds related to GRF or the peptides of U.S. Pat. No. 4,411,890. These peptides, while considerably smaller than growth hormones are still susceptible to various proteases. As with most peptides, their potential for oral bioavailability is low. WO 94/13696 refers to certain spiropiperidines and homologues which promote release of growth hormone. Preferred compounds are of the general structure shown below. ##STR2##
WO 94/11012 refers to certain dipeptides that promote release of growth hormone. These dipeptides have the general structure ##STR3##
The compounds of WO 94/11012 and WO 94/13696 are reported to be useful in the treatment of osteoporosis in combination with parathyroid hormone or a bisphosphonate.